Comparison of the Indian version of Health Assessment Questionnaire Score and Short Form 36 Physical Function Score in rheumatoid arthritis using Rasch analysis

ObjectiveThe health assessment questionnaire (HAQ) has been modified by many investigators to suit the culture and lifestyle of Indian population and these have been validated using traditional approaches. The goal of this study was to further validate the Indian version of HAQ published in 2002 by modern psychometric analysis, specifically by examining fit of the scale's data to the Rasch measurement model.MethodsA cross-sectional study was performed on 46 patients with rheumatoid arthritis (RA) from a single center in western India. Demographic characteristics, pain score and global perception of health were recorded on visual analogue scale. Functional outcome was assessed with the Indian HAQ and Short Form 36 physical function (SF 36-PF). Rasch analysis was performed to examine the property of various measures and to compare them on a common scale.ResultThe mean age ± SD was 45 ± 14.19 years and mean duration was 35.5 ± 52 months. 82.6% were women. The Indian HAQ highly correlated with SF 36-PF (r = 0.812, P < 0.001). Both the indices showed a moderate correlation with fatigue, pain, global health perception as well as disease activity scores (DAS28). Both the indices satisfied the Rasch model and were unidimensional with adequate person separation and reliability. Nine out of the 12 items in Indian HAQ were fitting in the Rasch model while in SF 36-PF scale nine out of 10 were fitting in the Rasch model. Three items in the HAQ (a) sitting cross-legged, (b) bending, and (c) lifting a cup were not fitting in the Rasch model, while one item of SF 36 ‘walking one block’, was not fitting in the Rasch model. 2.2% of patients assessed by Indian HAQ had 0 score (floor effect), while none had 3 score (ceiling effect), while 15.2% had maximum SF 36-PF score (ceiling effect) while none had 100 score (floor effect).ConclusionBoth Indian HAQ and SF 36-PF provide unidimensional measure of physical functioning in RA. SF 36-PF has significant psychometric advantage over Indian HAQ in RA in our cohort.     

Association of concomitant fibromyalgia with worse disease activity score in 28 joints,health assessment questionnaire,and short form 36 scores in patients with rheumatoid arthritis

Objective

To study the association of the presence of fibromyalgia (FM) with the Disease Activity Score in 28 joints (DAS28), the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study Short Form 36 (SF‐36) health survey in patients with rheumatoid arthritis (RA).

Methods

A total of 270 outpatients with RA were enrolled in a prospective cross‐sectional study. The patients underwent clinical evaluation and application of the HAQ and SF‐36 questionnaires. Disease activity was evaluated using the DAS28 score. FM and RA diagnoses were made according to American College of Rheumatology criteria.

Results

The overall prevalence of FM was 13.4%. This group of patients had a higher prevalence of female sex, older mean age, higher functional class, and longer morning stiffness than patients with only RA. Mean ± SD DAS28 scores were significantly higher in patients with RA and FM (5.36 ± 0.99) than in patients with RA only (4.03 ± 1.39; P < 0.001). In a multivariable linear regression analysis, FM was an important predictor of the DAS28 score, even after adjusting for the erythrocyte sedimentation rate, number of swollen joints, functional class, number of disease‐modifying antirheumatic drugs currently in use, current dose of steroids, and articular erosions. HAQ and SF‐36 scores were also worse in patients with RA and associated FM.

Conclusion

FM is related to worse scores on the DAS28, HAQ, and SF‐36 in patients with RA. The presence of FM may have major implications in the interpretation of the DAS28 score because it is related to higher scores independently of objective evidence of RA activity.     

Use of the short form 36 (SF36) for health status measurement in rheumatoid arthritis

The patient-administered Health Assessment Questionnaire (HAQ) is widely used in rheumatology studies. Another health quality assessment technique commonly used for other non-rheumatological conditions is the 'Short Form 36' (SF36). This has questions designed to assess eight aspects of health ranging from physical limitations to general perceptions of vitality and mental well-being. This study presents information on the health status of 137 patients with rheumatoid arthritis (RA) assessed by both the SF36 and HAQ. Summary statistics are given for the elements of the SF36 according to age, gender, disease measures of RA and the presence of co-morbidity. There were significant associations between the physical functioning score of the SF36 and the HAQ score. with other measures of disease activity and severity, and with co-morbidity, although there was considerable inter- patient variability. These findings suggest that future applications of health status questionnaires are possible.      

Validation and usefullness of Indian version (CRD Pune) health assessment questionnaire: Drug trials,community practice and COPCORD Bhigwan population study (1994–2012)

BackgroundStanford HAQ (S-HAQ) and several versions are used worldwide to measure physical function. Based on traditions and life style, a maiden Indian version (CRD Pune) was developed and used extensively (1996–2011). We report clinimetric properties and long term use.MethodsThe Indian version was finalized in a step wise consensus building process between doctors, community and patients. It remained similar to S-HAQ in basic structure (categories) and score/disability index. Current data was selected from controlled drug trials in active RA, referral community patients (clinic and camps) and WHO ILAR COPCORD (community oriented program for control of rheumatic diseases) Bhigwan. Standard statistics were used; significant p < 0.05.ResultsTest–retest and correlation statistics confirmed face and content (Cronbach's index >0.8) and construct validity and reliability at several time points. There was fair to good (0.2–0.6) correlation between Indian HAQ and pain visual analog scale, joint counts for pain/tenderness and swelling, sedimentation rate and radiological score (joint damage). The efficacy variables explained up to 70% variation in HAQ (dependent) regression models. The Indian HAQ scored significantly higher than the S-HAQ but the difference was not clinically relevant. The Indian HAQ was sensitive to change (effect size 0.7) over 24 week treatment with hydroxychloroquin. Generic use in COPCORD survey showed moderately severe HAQ disability in all patient groups including ‘ill-defined aches’ and soft tissue rheumatism. HAQ improved patient satisfaction.ConclusionThe Indian HAQ (CRD Pune) was a valid and useful patient outcome measure and improved compliance (long term follow up).     

The relationship between disease activity and depression in Egyptian patients with rheumatoid arthritis

Aim of the workTo estimate the prevalence of depression and its relationship with disease activity parameters in Egyptian patients with RA.Patients and methodsA cross sectional study was conducted on 170 patients with RA. The following values were assessed for each patient: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), swollen and tender joint counts (SJC and TJC), disease activity score 28 (DAS28), health assessment questionnaire score (HAQ), visual analogue scale (VAS) of pain and hospital anxiety and depression scale-depression subscale (HADS-D).ResultsThe prevalence of depression was 15.29% (26 RA patients). In the depressed RA patients, positive significant correlations were found between HADS-D score and age, disease duration, HAQ score, VAS, DAS28 score and CRP. However, no significant correlation was found between HADS-D score and ESR, number of swollen and tender joints. No significant difference (P > 0.05) was found between depressed male and female patients with RA.ConclusionPatients with RA and co-morbid depression have worse health outcomes. RA cases should be monitored for accompanying depression during follow-up. The identification and treatment of depression in RA paramount to the overall management of RA.     

Health‐related quality of life of patients with psoriatic arthritis: A comparison with patients with rheumatoid arthritis

Objective

To compare health‐related quality of life (QOL) between patients with psoriatic arthritis (PsA) and patients with rheumatoid arthritis (RA), using the Medical Outcomes Study Short Form health survey (SF‐36) and the Health Assessment Questionnaire (HAQ).

Methods

Both the SF‐36 and the HAQ were administered to 107 PsA patients attending the University of Toronto Psoriatic Arthritis Clinic between January 1 and December 31, 1994, and to 43 RA patients attending a University of Toronto–affiliated RA clinic during the same period. Standardized assessments of disease activity and severity were also performed at each clinic visit. Logistic regression analysis was used to compare health‐related QOL between PsA and RA.

Results

Both patient populations experienced lower physical health compared with that of a general population sample. The RA patients demonstrated more active inflammatory disease at the time of assessment than the PsA patients. The PsA patients were younger, and more were men. Logistic regression analyses showed that patients with PsA reported higher levels of vitality than patients with RA, even after adjusting for the observed differences in clinical and demographic characteristics. PsA patients, however, reported more role limitations due to emotional problems and more bodily pain after adjusting for the difference in vitality and other covariates.

Conclusions

Although both patient populations experienced reduced QOL, there were some meaningful differences in how the 2 conditions affect health‐related QOL. Further, it appeared that there may be unique disabilities associated with the psoriasis dimension of PsA.

     

Assessing the impact of rheumatoid arthritis on quality of life in a group of patients attending a rheumatology clinic in Sri Lanka

BackgroundRheumatoid arthritis (RA) has a worldwide distribution affecting 0.5–3% of the population. We used Stanford Health Assessment Questionnaire (HAQ) to assess the quality of life (QOL) in a sample of patients with RA. Disability assessment component of the HAQ; the HAQ-DI, assesses a patient's level of functional ability and has been validated and used in clinical trials extensively.ObjectiveTo find the impact of illness on quality of life, in a sample of patients with RA using HAQ, and to calculate the HAQ-DI. Additionally, to find the age distribution and relationship of HAQ-DI with VAS, DAS28 and duration of illness.MethodologyA self administered questionnaire was used in a random sample of 100 patients attending a rheumatology clinic. Statistical analysis was done using the SPSS statistical package version 17 (SPSS Institute, Chicago).ResultsWe had a 100% female population with mild disease [HAQ-DI (0–<1)] in 62% of patients, while severe disease (≥2 and ≤3) was found in 5%. RA prevalence was highest in 41–50 years group (mean age ± SD = 50.8 ± 11.5 years). VAS had a positive correlation with HAQ-DI. Relationship of HAQ-DI and DAS28 was not statistically significant (p = 0.72), although there was a positive correlation between DAS28 and HAQ-DI in disease duration more than 5 years group (r = 0.19). Mean HAQ score was the highest in more than 10 years disease duration population (p = 0.006).ConclusionIn a busy clinic setting, simple parameters like disease duration and VAS give an indication about the functional effect of illness on a patient's quality of life.     

The benefits of yoga for rheumatoid arthritis: results of a preliminary, structured 8-week program

The aim of this study was to measure the effects of a bi-weekly Raj yoga program on rheumatoid arthritis (RA) disease activity. Subjects were recruited from among RA patients in Dubai, United Arab Emirates by email invitations of the RA database. Demographic data, disease activity indices, health assessment questionnaire (HAQ), and quality of life (QOL) by SF-36 were documented at enrollment and after completion of 12 sessions of Raj yoga. A total of 47 patients were enrolled: 26 yoga and 21 controls. Baseline demographics were similar in both groups. Patients who underwent yoga had statistically significant improvements in DAS28 and HAQ, but not QOL. Our pilot study of 12 sessions of yoga for RA was able to demonstrate statistically significant improvements in RA disease parameters. We believe that a longer duration of treatment could result in more significant improvements.     

Health‐related quality of life in women with symptomatic hand osteoarthritis: A comparison with rheumatoid arthritis patients,healthy controls,and normative data

Objective

Data on the burden of disease and impact on health‐related quality of life (HRQOL) in hand osteoarthritis (OA) are limited. The goal of this study was to compare HRQOL in patients with hand OA with HRQOL in patients with rheumatoid arthritis (RA), healthy controls, and normative data from the general population.

Methods

A total of 190 women with hand OA were compared with 194 women with RA and 144 healthy women of the same age. Health status was measured using the Short Form 36 (SF‐36), Short Form 6D (SF‐6D), modified Health Assessment Questionnaire (M‐HAQ), pain and fatigue visual analog scales, and grip strength. Scores were compared by analysis of variance and a multivariate analysis of covariance, adjusting for age, number of comorbidities, and years of education. Gaps between patients and population subjects were assessed by calculating S scores on all dimensions of the SF‐36.

Results

Hand OA and RA patients had worse scores on all assessed dimensions of subjective health compared with healthy controls. RA patients showed poorest general health (SF‐36), poorest physical function (M‐HAQ, SF‐36 physical, grip strength), and highest level of fatigue compared with hand OA patients. Hand OA patients reported poorer mental health. Mean utility scores (SF‐6D) in hand OA and RA were 0.64 and 0.63, respectively, with a mean difference compared with healthy controls of 0.13 in hand OA and 0.14 in RA patients. S scores confirmed a marked disparity between individuals with a rheumatic diagnosis (hand OA, RA) and population subjects.

Conclusion

This study illustrates that patients with hand OA experience a broad impact on HRQOL compared with healthy controls. Fatigue and physical function are worse in RA than hand OA.     

Improvement of the HAQ score by infliximab treatment in patients with RA: its association with disease activity and joint destruction

Abstract

We conducted a two-year prospective study to clarify the efficacy of infliximab at improving the health assessment questionnaire (HAQ) score and associated factors in 67 patients with advanced rheumatoid arthritis (RA). All patients were scheduled to receive infliximab at a dose of 3 mg/kg at weeks 0, 2, 6 and every eight weeks thereafter through to week 102, and were fully examined at the time of each infusion. Parameters of disease activity such as the serum level of C-reactive protein (CRP), the serum level of matrix metalloproteinase-3 (MMP-3) and the 28-joint disease activity score (DAS28) were obtained, and the functional capabilities of the patients were assessed using the HAQ score. The serum CRP, the MMP-3, the DAS28(CRP) level, and the mean HAQ score decreased rapidly at two weeks after the start of infliximab treatment (CRP from 3.7 to 0.9 mg/dl, MMP-3 from 362.3 to 192.8 ng/ml, DAS28(CRP) from 5.6 to 3.7, and HAQ score from 1.5 to 0.9). Compared with the baseline values, the mean progression of the modified van der Heijde (vdH)–Sharp score after one year was 4.4 ± 5.8 (median: 3.0), and that after two years was 3.1 ± 6.9 (median: 1.0). A 93% reduction in the rate of joint destruction, as measured using the vdH–Sharp score, was estimated after infliximab therapy. Patients with less joint damage (shorter disease duration or lower vdH–Sharp score) regained more of their daily activities. The present study demonstrated the importance of activity control before the progression of irreversible factors, such as joint destruction, for maintaining the functional capacities of RA patients.     

Quality of life assessment in Egyptian rheumatoid arthritis patients: Relation to clinical features and disease activity

Aim of workTo assess the impact of rheumatoid arthritis (RA) on the health related quality of life (QoL) of patients, using the 36-item short form (SF-36) and to study the influence of different disease variables.Patients and methodsEighty-six RA patients were recruited from the Rheumatology and Rehabilitation outpatient of Assiut University Hospital. Forty-three, age and sex matched subjects were included as controls. The QoL was measured in all subjects using the SF-36 health survey. Disease activity was assessed in RA patients by the disease activity score (DAS28).ResultsAll domains of the SF36 were significantly lower in the patients (p < 0.0001). Patients with a lower educational level and those unemployed had significantly lower SF36 components. Those with a disease duration >5 years, positive rheumatoid factor and higher disease activity had a significantly lower SF36 physical component. Patients receiving hydroxychloroquine or prednisolone had significantly lower mental component. Significant negative correlation of the SF36 physical and mental components was found with both disease duration (p = 0.01 and p < 00001 respectively) and DAS28 (p < 0.0001 for both). Rheumatoid factor negatively correlated with the physical component (p < 0.0001). Regression analysis showed that disease duration was the most profound predictor of both SF36 components (p < 0.0001).ConclusionThe quality of life is impaired in Egyptian RA patients and disease duration was the most significant predictor. Routine assessment of the health-related QoL in those patients is recommended to detect and monitor the impact of the disease and medications used on different aspects of their quality of life.     

Measuring utilities by the time trade-off method in Tunisian rheumatoid arthritis patients

The objective of this study was to determine the feasibility, reliability and validity of the time trade-off (TTO) in Tunisian rheumatoid arthritis (RA) patients. The TTO was used to measure the utility in 122 RA patients with increasing difficulty in performing activities of daily living. The 1-week test–retest reproducibility was studied in 57 patients using the intraclass correlation coefficient (ICC). Validity was evaluated by comparison with other outcome measures: utility rating scale (RS), quality of life (QOL) [arthritis impact measurement scale 2 (AIMS2), rheumatoid arthritis quality of life (RAQOL)], functional status [health assessment questionnaire (HAQ), Lee index] and disease activity score (DAS). Eight patients (6.6%) did not complete the TTO. The median value of the TTO score was 0.655 (0.019–1.000). The ICC for reliability of the TTO was 0.89 (p<0.001). The TTO showed poor to moderate correlation (Spearmans correlation coefficients between 0.2 and 0.409, p<0.01) with AIMS2, RAQOL, HAQ and Lee index. We did not find any correlation between TTO and DAS. Multiple regression analysis showed that only 32% of TTO scores could be explained. The TTO method appeared to be reliable in a group of Tunisian RA patients, but TTO values were poorly to moderately related to measures of QOL, functional ability, and disease activity. We think that TTO and RS are not feasible for use in RA patients.     

DAS 28 for defining remission in rheumatoid arthritis in Indian patients

ObjectiveTo establish DAS 28 and DAS 28-3 scores that best define remission in Indian patients with rheumatoid arthritis (RA).Patients and MethodsAll patients diagnosed with RA visiting AIIMS, New Delhi over a period of 3 months were recruited. Clinical assessment included 28 joint counts for swelling and tenderness, duration of early morning stiffness, patient global assessment of disease activity, fatigue, joint pains and ESR. DAS 28 and DAS 28-3 scores were calculated and receiver operating characteristics curve analysis was performed to define cutoff values utilizing ‘ACR 5/6’ and ‘ACR 4/5’ remission criteria.ResultsSubjects included 207 patients (M: 44; F: 163) with mean age of 47.4 ± 12.6 years, median disease duration of 8 [4.12–14] years.‘ACR 5/6’ and ‘ACR 4/5’ criteria for remission were satisfied by 34 (16.42%) and 44 patients (21.25%) patients, respectively. DAS 28 score of 2.94 (sensitivity 84.4%, specificity 85.3%) and DAS 28-3 score of 3.02 (sensitivity 82.1%, specificity 82.4) best defined the ‘ACR 5/6’ remission. Corresponding values using ‘ACR 4/5’ remission were 3.04 (sensitivity 85.9%, specificity 84.1%) for DAS 28 and 3.05 (sensitivity 82.2%, specificity 81.8%) for DAS 28-3.ConclusionsA cutoff value < 3 for both DAS 28 and DAS 28-3 defines remission in RA in Indian patients.     

Simplified Disease Activity Index as an index of disease activity in patients with rheumatoid arthritis: a comparison with DAS28

IntroductionVarious factors are known to determine the disease activity in patients with rheumatoid arthritis (RA). The main objective of this study was to establish the validity of the new tool of measurement of disease activity, Simplified Disease Activity Index (SDAI), in patients with RA in Indian population.MethodsAll patients with RA fulfilling the ACR classification criteria attending the rheumatology clinic at Nizam's Institute of Medical Sciences, Hyderabad over a period of 3 months were included in the study. A detailed assessment of each patient including their demographic characteristics, duration of the disease, number of tender and swollen joint counts, Westergren's ESR and C-reactive protein (mg/dL), patient's and physician's global assessment by VAS (0–10) were recorded. DAS28 and SDAI were calculated for each patient. Statistical analysis was done.ResultsTwo hundred and sixteen patients were included in the study comprising 184 women and 32 men. Mean age of the patients was 42.94 ± 11.23 years and mean duration of disease was 4.10 ± 4.02 years. Mean DAS28 and SDAI were 5.19 ± 1.48 and 24.2 ± 16.06 respectively. ROC curve revealed that discriminative ability of SDAI was better than that of DAS28. The optimal cut-off points for treatment changes were 4.46 for DAS28 (sensitivity 88%, specificity 87.5%) and 12.6 for SDAI (sensitivity 92%, specificity 83%).ConclusionSDAI is a valid tool for measurement of disease activity in RA in Indian population and is as good as DAS28 in its ability to assess the patient's status.     

The relationship of serum calprotectin with disease activity,functional status,ultrasonographic findings and radiological damage in rheumatoid arthritis patients

Aim of the workTo measure the levels of serum calprotectin (CLP) in rheumatoid arthritis (RA) patients and to assess its association with disease activity, functional status, ultrasonographic findings, and radiological damage.Patients and methodsThis study included 47 RA patients and 33 controls. The erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), C-reactive protein (CRP), disease activity score (DAS28), health assessment questionnaire (HAQ), modified Larsen radiological score, musculoskeletal ultrasound and serum CLP levels were assessed.ResultsThe mean age of the patients was 42.5 ± 12.8 years; 34 females and 13 males (F:M 2.6:1) with a mean disease duration of 2.6 ± 1.1 years. RF was positive in 72%. CLP level was significantly increased in patients compared to control (2.78 ± 0.89 μg/ml vs. 0.84 ± 0.5 μg/ml; p < 0.001) and in those with activity (3.27 ± 0.75 μg/ml) compared to those in remission (1.92 ± 0.15 μg/ml). A significant correlation was detected between CLP and DAS28, ESR, CRP, HAQ, and modified Larsen scores (p < 0.001). On regression, tender and swollen joint counts, ESR, CRP, HAQ, modified Larsen, ultrasound 7 score and CLP level were significant predictors of activity but were insignificant on multivariate analysis. At a cut-off value of 2.35 μg /ml CLP can significantly differentiate active RA patients from those in remission (AUC 0.95; p < 0.001) at a sensitivity of 90%, specificity of 100%, and accuracy of 95%.ConclusionThe serum CLP levels were significantly high in RA patients and these high levels were associated with disease activity, functional status, ultrasonographic findings, and radiological damage.     

Long‐term followup of health status in patients with severe rheumatoid arthritis after high‐dose chemotherapy followed by autologous hematopoietic stem cell transplantation

Objective

High‐dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (HSCT) is a new treatment for patients with severe, refractory rheumatoid arthritis (RA). The present study was undertaken to assess the health status of patients with severe RA over a long‐term followup period after treatment with HDC + HSCT.

Methods

Health status and utility scores were assessed in 8 patients before and after treatment with HDC + HSCT. Patients were followed up for 5 years posttransplantation. Health status was assessed by the Health Assessment Questionnaire (HAQ), the RAND‐36 version of the Short Form 36 (SF‐36) health survey, and the Arthritis Impact Measurement Scales (AIMS). Utility scores were calculated using the EuroQol (EQ‐5D) questionnaire and the SF‐36–derived utility index (called the SF‐6D), from which quality‐adjusted life years (QALYs) were derived.

Results

Most measures of health status improved compared with baseline in the first 2 years posttransplantation, notably HAQ and AIMS scores and scores on the functional status, general health, and health change summary scales of the RAND‐36 version of the SF‐36. Utility scores derived from the EQ‐5D questionnaire and the SF‐6D also increased significantly after transplantation. This was reflected in the 0.28 QALYs gained compared with baseline. For a putative 50‐year‐old RA patient with a life expectancy of 20 years, a threshold analysis revealed that HDC + HSCT yielded more QALYs than conventional therapy when treatment‐related mortality (TRM) was <2.8%.

Conclusion

HDC + HSCT temporarily increased the functionality and health status of patients with severe, refractory RA. With a reported TRM of 1.3%, HDC + HSCT can be considered a realistic treatment option for patients with severe RA.

     

Impact of rheumatoid arthritis on quality of life

Quality of life (QOL) of patients affected by various diseases is now recognized as an important outcome variable. Consenting patients with rheumatoid arthritis (American College of Rheumatology criteria) were included in the study. Quality of life was assessed using the World Health Organization Quality of Life assessment, short form (WHOQOL-BREF). Disease activity was assessed by the Disease Activity Score (DAS28) for 3 variables and functional disability by the Health Assessment Questionnaire (HAQ). Extra-articular manifestations (ExRA) were diagnosed clinically. Seventy-five age-matched normal controls and 136 patients (19 males) were included. The mean duration of rheumatoid arthritis (RA) was 9 ± 5.8 years. The mean DAS28 and HAQ were 4.43 ± 1.4 and 0.97 ± 1.6, respectively. At least one ExRA was present in 30 (22.1%) patients. The WHOQOL scores were significantly lower in patients with RA compared to normal controls. Patients and normal controls scored highest in the social relationship domain. There was significant inverse correlation of HAQ with all four domains of WHOQOL. There was significant inverse correlation of DAS28 with the physical health and psychological domains. Patients with ExRA scored significantly lower in the physical health domain of WHOQOL. Multiple regression analysis showed only HAQ to independently affect QOL. Quality of life is compromised in patients with RA. Patients and normal controls scored higher in the social relationship domain. Functional disability is the most important factor affecting QOL in RA.     

Baseline comorbidities in patients with rheumatoid arthritis who have been prescribed biological therapy: A case control study

AimTo determine whether rheumatoid arthritis (RA) patients who have been prescribed biological agents exhibit a different comorbidity burden than RA patients who take disease-modifying antirheumatic drugs (DMARDs) alone, and to understand the association between comorbidity and other variables, as well as the association between comorbidity and multimorbidity.MethodsThis observational case–control study included 114 RA patients treated with biological agents and a control group comprising 163 sex- and age-matched RA patients treated with DMARDs only. Current and previous data regarding the patients’ disease activity, comorbidities, and treatments were collected. The data were analysed using bivariate and multivariate regression models.ResultsThe patients who were prescribed biological agents exhibited poorer disease control, received more DMARDs and steroids, and underwent more total joint arthroplasties compared with the patients in the control group. However, the risk factors for cardiovascular disease and the comorbidity frequency were similar between cases and controls. The most prevalent comorbidities were hypertension, obesity, and respiratory, thyroid, and upper gastrointestinal disorders. The incidence of cardiovascular disease was low, and only 29% of the patients exhibited multimorbidities. A bivariate association of age, late diagnosis, joint replacements and a high score on the health assessment questionnaire score (HAQ) with comorbidity was observed. There were also correlations between the Charlson index and age, joint reconstructive surgery, disease activity (DAS28), and HAQ score. However, when binary logarithmic regression models were applied, only patient age remained significantly associated with comorbidity and multimorbidity [hazard ratio, 1.08; 95% confidence interval, 1.05–1.12; p < 0.0005].ConclusionRA patients taking biological drugs have a comorbidity burden equivalent to those treated with DMARDs alone. Age is the main predictive factor of comorbidity in these patients.     

Functional disability in relation to radiological damage and disease activity in patients with rheumatoid arthritis in remission

OBJECTIVE: To investigate the relationship between functional disability, disease activity and radiological damage in patients with rheumatoid arthritis (RA) in remission. METHODS: One hundred and eighty-six patients with RA in remission or with low disease activity were studied. The following variables were assessed at one time point: joint count, visual analog scale for pain, functional disability, i.e., health assessment questionnaire (HAQ) score, radiological joint damage as assessed by radiographs of hands and feet and scored according the Sharp-van der Heijde method, and presence of comorbidity. Disease activity was expressed as the disease activity score (DAS). Correlations were calculated by Spearman's rho coefficient of correlation. In addition, variables associated with the score were analyzed by logistic regression. RESULTS: The median HAQ score was 0.25 [interquartile (IQR) range 0-0.75] and the median DAS was 1.0 (IQR 0.7-1.5). Of the 186 RA patients included, 82% were in remission according to the DAS. The median joint damage as assessed by the Sharp-van der Heijde score was 21 (IQR 9-74). Functional disability was significantly correlated with pain (rho 0.48, p < 0.001), disease activity (rho 0.42; p < 0.001), disease duration (rho 0.39; p < 0.001), radiographic joint damage (rho 0.37; p < 0.001), and age (rho 0.19; p = 0.01). In a logistic regression model functional disability was independently related to presence of pain, disease activity, radiographic joint damage and disease duration in decreasing order of strength, but not to age. sex and co-morbidity. CONCLUSION: Patients with RA who are in remission might experience minimal functional disability and radiographic joint damage. Functional disability in RA patients in remission is most strongly related to the presence of pain and in lesser extent to disease activity, radiographic joint damage, and disease duration.